The art and science of reviewing manuscripts for orthopaedic journals: Part I. Defining the review

The peer review process is integral to the functioning of all scientific journals and plays a pivotal role in the publication of new scientific material. Timeliness, freedom from bias, and proper review etiquette are essential for an effective review. Each type of scientific article demands a slightly different reviewing technique. Clinical research articles require that a proper question be asked and that the study methodology allows the question to be answered effectively. All studies dealing with human subjects need to be approved by the Institutional Review Board. Clinical review articles have specific criteria to determine how they should be constructed and when they should be published, whereas basic science research articles should be evaluated for their experimental method as well as the relevance of the conclusions to the data. Finally, case reports have an important place in the scientific literature, but the rationale for publishing any individual case needs to be clearly established.

The art and science of reviewing manuscripts for orthopaedic journals: Part II. Optimizing the manuscript: practical hints for improving the quality of reviews

Manuscripts submitted to musculoskeletal journals have several key components that need to be critically evaluated. There are specific methods to assess the abstract, illustrations, references, and other major elements of a manuscript under review. If each of these elements is assessed methodically, not only does the quality of the review improve, but it becomes more useful for the journal editor. Additionally, the method in which the review is conveyed has a marked impact on its usefulness. There should be a concise evaluation of the entire work, stating whether a publication should or should not be pursued. For poor manuscripts, several bulleted points that indicate the fatal flaw(s) are sufficient, but for good manuscripts, a systematic itemization of weaknesses will improve the quality of the manuscript. Reviews should not be derogatory and should be prompt and to the point.

Curricular reform in musculoskeletal medicine: needs, opportunities, and solutions

Musculoskeletal medicine is not taught adequately in American medical schools and the predictable consequences are seen. Students cannot show cognitive mastery of the subject and lack confidence in this topic. To address this, the Academic Orthopaedic Society held a symposium on medical school education at its annual meeting in 2001. There, the panelists presented an analysis of the problem and proposed solutions. Specifically, it was noted that because of the autonomy of the various schools and their varied approaches to teaching, it would be unlikely that one monolithic and mandated plan could be effective on a national basis. Rather, successful reform would comprise a coalition-based effort to define learning objectives, to provide teaching materials, and to create forums for sharing resources. Recruitment of national organizations was thought to be essential. Finally, it was felt that although inadequate education is neither new nor necessarily unique among disciplines, the coming year or two, the beginning of the Bone and Joint decade, was seen to be a particularly auspicious time for attempting curricular reform.

Biomechanical evaluation of fixation of posterior acetabular wall fractures

Reproducible fractures of the posterior wall of the acetabulum were created in 10 paired hemipelves from fresh human cadavers. Under anterior-to-posterior loading by a Materials Testing System machine, the load to failure of fixation of the acetabular fractures treated with steel pelvic reconstruction plates and steel screws was significantly higher than that of fixation with titanium ribbons and titanium screws. Forces as little as 725 newtons applied directly to the fragment caused fixation failure; even the most secure form of fixation failed when a relatively small force of 2,123 newtons was applied. These results emphasize the importance of appropriate postoperative measures, such as limitation of hip flexion and restricted weightbearing, to minimize the force directed against the posterior wall until the fracture has healed. Secure fixation of fractures of the posterior wall of the acetabulum is critical, since loss of fixation results in instability and joint incongruity, which limit the options for reconstruction.

Expanding roles of the orthopaedic surgeon

Many sources predict an oversupply of orthopaedic surgeons in the United States continuing into the next 30 years. The most attractive solution to this problem is to expand the scope of orthopaedic practice by regaining direct patient access to orthopaedic specialty care, by developing and bringing new technologies and treatments to the marketplace quickly, and by developing alternatives to the typical orthopaedic practice such as expanding nonoperative care, improving the quality of the office practice, and exploring volunteer opportunities.

Nonunion treatment with pulsed electromagnetic fields

Noninvasive, pulsed electromagnetic field treatment, when properly employed, was effective in securing healing of ununited fractures in 64.4% of 149 patients. The effectiveness of this modality can be ascertained after three months of intensive use in more than 85% of patients, thus enabling the clinician to decide to terminate treatment, continue electrostimulation, or abandon it in favor of another treatment modality. The success of treatment is dependent upon certain variables. Anatomic location of the nonunion is important. Higher healing rates were noted in the tibia than in the femur or humerus. In some conditions, combined electrostimulation and bone grafting was more effective than either measure alone. Young patients healed more rapidly than older patients. Electrostimulation is more effective when instituted within two years of the original fracture than when started at longer intervals after the injury. Infection, either quiescent or actively draining, does not seem to affect the overall results. Of greatest importance is patient adherence to the treatment protocol as outlined, with emphasis placed on adequate immobilization of the fracture and absolute nonweight-bearing during treatment. Considering these factors and in light of the very rare frequency of short-term side effects, the use of pulsed electromagnetic fields appears to be a reasonable choice of treatment in the management of ununited fractures.